Gawande Quotes

#1. Gawande reports that research has shown that patients commonly prefer to have others make their decisions for them. Though as many as 65 percent of people surveyed say that if they were to get cancer, they would want to choose their own treatment, in fact, among people who do get

Barry Schwartz

#2. The companies' most effective tactic, however, was simply to put out the goods and let surgeons play.

Atul Gawande

#3. The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don't.

Atul Gawande

#4. Thinking about averting plane crashes in 1935, or stopping infections of central lines in 2003, or rescuing drowning victims today, I realized that the key problem in each instance was essentially a simple one, despite the number of contributing factors.

Atul Gawande

#5. Amount of freedom you have in your life is not the measure of the worth of your life. Just as safety is an empty and even self-defeating goal to live for, so ultimately is autonomy.

Atul Gawande

#6. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens. Measurements of people's minute-by-minute

Atul Gawande

#7. We are used to thinking of doctoring as a solitary, intellectual task. But making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their hands.

Atul Gawande

#8. AT THE CENTER of Wilson's work was an attempt to solve a deceptively simple puzzle: what makes life worth living when we are old and frail and unable to care for ourselves?

Atul Gawande

#9. The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.

Atul Gawande

#10. People say that the most expensive piece of medical equipment is the doctor's pen. It's not that we make all the money. It's that we order all the money.

Atul Gawande

#11. This is normal. Although the processes can be slowed - diet and physical activity can make a difference - they cannot be stopped.

Atul Gawande

#12. The lesson seems almost Zen: you live longer only when you stop trying to live longer.

Atul Gawande

#13. Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.

Atul Gawande

#14. This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.

Atul Gawande

#15. Whereas today people often understate their age to census takers, studies of past censuses have revealed that they used to overstate it.

Atul Gawande

#16. We want progress in medicine to be clear and unequivocal, but of course it rarely is. Every new treatment has gaping unknowns - for both patients and society - and it can be hard to decide what do do about them.

Atul Gawande

#17. The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front.

Atul Gawande

#18. Even our brains shrink: at the age of thirty, the brain is a three-pound organ that barely fits inside the skull; by our seventies, gray-matter loss leaves almost an inch of spare room.

Atul Gawande

#19. Those of us in medicine don't help, for we often regard the patient on the downhill as uninteresting unless he or she has a discrete problem we can fix.

Atul Gawande

#20. And that summer, as Hurricane Ella made its way toward the city, an emergency crew worked at night under veil of secrecy to weld two-inch-thick steel plates around the two hundred critical bolts, and the building was secured. The Citicorp tower has stood solidly ever since. The

Atul Gawande

#21. I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.

Atul Gawande

#22. So for any new checklist created from scratch, you have to pick the type that makes the most sense for the situation.
The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory.

Atul Gawande

#23. The earliest portions to shrink are generally the frontal lobes, which govern judgment and planning, and the hippocampus, where memory is organized. As a consequence, memory and the ability to gather and weigh multiple ideas - to multitask - peaks in midlife and then gradually declines.

Atul Gawande

#24. I was willing to be rejected. That's what allows you to be a good salesperson. You have to be willing to be rejected.

Atul Gawande

#25. You know, there's this phase of people's lives in which they can't really cope on their own, and we ought to find a way to make it manageable.

Atul Gawande

#26. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it. Patients

Atul Gawande

#27. The vast majority of doctors really do try to take the money out of their minds. But to provide the best possible care requires using resources in a way that keeps you viable but improves the quality of care.

Atul Gawande

#28. You can't make a recipe for something as complicated as surgery. Instead, you can make a recipe for how to have a team that's prepared for the unexpected.

Atul Gawande

#29. Michael Jordan always had to wear University of North Carolina boxer shorts under his Chicago Bulls uniform.

Atul Gawande

#30. All the same I fear what happens when we expand the terrain of medical practice to include actively assisting people with speeding their death. I am less worried about the abuse of these powers than I am about dependence on them.

Atul Gawande

#31. When, as the researchers put it, "life's fragility is primed," people's goals and motives in their everyday lives shift completely. It's perspective, not age, that matters most. Tolstoy

Atul Gawande

#32. ODTAA syndrome: the syndrome of One Damn Thing After Another.

Atul Gawande

#33. But scientific advances have turned the processes of aging and dying into medical experiences,

Atul Gawande

#34. One essential characteristic of modern life is that we all depend on systems - on assemblages of people or technologies or both - and among our most profound difficulties is making them work.

Atul Gawande

#35. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness.

Atul Gawande

#36. As a person's end draws near, there comes a moment when responsibility shifts to someone else to decide what to do.

Atul Gawande

#37. LOU SANDERS WAS on his way to joining the infantilized and catatonic denizens belted into the wheelchairs of a North Andover nursing home

Atul Gawande

#38. What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding? The

Atul Gawande

#39. It is common to misconceive how checklists function in complex lines of work. They are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals. And

Atul Gawande

#40. I was never born to write. I was taught to write. And I am still being taught to write.

Atul Gawande

#41. People spend years of sixty-, seventy-, eighty-hour weeks building their base of knowledge and experience before going out into practice on their own - whether they are doctors or professors or lawyers or engineers. They have sought to perfect themselves.

Atul Gawande

#42. People readily demonstrate a willingness to sacrifice their safety and survival for the sake of something beyond themselves, such as family, country, or justice.

Atul Gawande

#43. That the chance to shape one's story is essential to sustaining meaning in life;

Atul Gawande

#44. We are not omniscient or all-powerful. Even enhanced by technology, our physical and mental powers are limited.

Atul Gawande

#45. Percent of medical students take no course in geriatrics,

Atul Gawande

#46. When someone has come to you for your expertise and your expertise has failed, what do you have left? You have only your character to fall back upon - and

Atul Gawande

#47. I said there are at least two kinds of satisfaction, however, and the other has nothing to do with skill. It comes from human connection. It comes from making others happy, understanding them, loving them.

Atul Gawande

#48. We Have Medicalized Aging, and That Experiment Is Failing Us

Atul Gawande

#49. Pain is a symphony - a complex response that includes not just a distinct sensation but also motor activity, a change in emotion, a focusing of attention, a brand-new memory.

Atul Gawande

#50. The damage that the human body can survive these days is as awesome as it is horrible: crushing, burning, bombing, a burst blood vessel in the brain, a ruptured colon, a massive heart attack, rampaging infection. These conditions had once been uniformly fatal.

Atul Gawande

#51. That's how a doctor earns money, she told me. It's a war with insurance, every step of the way.

Atul Gawande

#52. If there is a credo in practical medicine, it is that the important thing is to be sensible.

Atul Gawande

#53. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet

Atul Gawande

#54. Just using a checklist requires [doctors] to embrace different values from ones we've had, like humility, discipline, teamwork.

Atul Gawande

#55. Each year, according to the U.S. Centers for Disease Control, two million Americans acquire an infection while they are in the hospital. Ninety thousand die of that infection. The

Atul Gawande

#56. Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.

Atul Gawande

#57. We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.

Atul Gawande

#58. Under conditions of complexity, not only are checklists a help, they are required for success.

Atul Gawande

#59. They provided assisted living, but no one seemed to think it was their job to actually assist him with living

Atul Gawande

#60. And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained? In

Atul Gawande

#61. In a fire, the metal can plasticize - lose its stiffness and bend like spaghetti. This was why the World Trade Center buildings collapsed,

Atul Gawande

#62. These are folks that keep people out of hospitals, out of emergency rooms, out of nursing homes. And not only that, they help people achieve more fulfilling lives.

Atul Gawande

#63. Drug and medical device companies offered invitations to free dinners around town nightly. And there were over five thousand three hundred salespeople from some twelve hundred companies registered in attendance here - more than one for every two surgeons. The

Atul Gawande

#64. Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on the present more than the future. Understanding

Atul Gawande

#65. Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of their practice.

Atul Gawande

#66. Wisdom is prudent strength.

Atul Gawande

#67. Human beings are social creatures. We are social not just in the trivial sense that we like company, and not just in the obvious sense that we each depend on others. We are social in a more elemental way: simply to exist as a normal human being requires interaction with other people.

Atul Gawande

#68. Obstetrics went about improving the same way Toyota and General Electric went about improving: on the fly, but always paying attention to the results and trying to better them. And

Atul Gawande

#69. Health care confronts us with a difficult test. We have never corrected failure in something so deeply embedded in people's lives and in the economy without the pressure of an outright crisis.

Atul Gawande

#70. Before taxiing out to the runway, we paused again for five more checks: whether anti-icing was necessary and completed, the autobrakes were set, the flight controls were checked, the ground equipment was cleared, and no warning lights were on. The three checklists

Atul Gawande

#71. This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.

Atul Gawande

#72. No matter what measures are taken, doctors will sometimes falter, and it isn't reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.

Atul Gawande

#73. Whatever the limits and travails we face, we want to retain the autonomy - the freedom - to be the authors of our lives.

Atul Gawande

#74. She felt her sanity slipping. She wanted to be a good daughter. She wanted her father to be safe, and she wanted him to be happy. But she wanted a manageable life, too.

Atul Gawande

#75. You want to ensure people can do it right 99 percent of time. When we have to fire one of our surgical trainees, it is never because they don't have the physical skills but because they don't have the moral skills - to practise and admit failure.

Atul Gawande

#76. The simpler way to say it is that perspective matters.

Atul Gawande

#77. One American in seven has no coverage, and one in three younger than sixty-five will lose coverage at some point in the next two years. These are people who aren't poor or old enough to qualify for government programs but whose jobs aren't good enough to provide benefits either.

Atul Gawande

#78. A failure often does not have to be a failure at all. However, you have to be ready for it-will you admit when things go wrong? Will you take steps to set them right?-because the difference between triumph and defeat, you'll find, isn't about willingness to take risks. It's about mastery of rescue.

Atul Gawande

#79. The evidence is that people who enter hospice don't have shorter lives. In many cases they are longer.

Atul Gawande

#80. But now the problem we face is ineptitude, or maybe it's "eptitude" - making sure we apply the knowledge we have consistently and correctly. Just making the right treatment choice among the many options for a heart attack patient can be difficult, even for expert clinicians.

Atul Gawande

#81. I think we are faced in medicine with the reality that we have to be willing to talk about our failures and think hard about them, even despite the malpractice system. I mean, there are things that we can do to make that system better.

Atul Gawande

#82. Instead they choose to accept their fallibilities. They recognised the simplicity and power of using a checklist.

Atul Gawande

#83. In one study, old people assigned to a geriatrics team stayed independent for far longer, and were admitted to the hospital less.

Atul Gawande

#84. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers. I wrote this book in

Atul Gawande

#85. It's an opaque term, intensive care. Specialists in the field prefer to call what they do critical care, but that still doesn't exactly clarify matters.

Atul Gawande

#86. If the conversation people think is coming is the 'death panel' conversation, that's a total failure.

Atul Gawande

#87. The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society.

Atul Gawande

#88. If end-of-life discussions were an experimental drug, the FDA would approve it.

Atul Gawande

#89. If I get hit by a bus tomorrow, my patients will not even be postponed. Another surgeon would step in and take over. The reason to do research and writing is that it at least makes me feel not entirely replaceable. If I didn't write, I don't know if I would do surgery.

Atul Gawande

#90. Their attitude seemed to result from incomprehension rather than cruelty, but as Tolstoy would have said, what's the difference in the end?

Atul Gawande

#91. In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die.

Atul Gawande

#92. When [disease] can't be stopped, that's where we become lost.

Atul Gawande

#93. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.

Atul Gawande

#94. But as your horizons contract - when you see the future ahead of you as finite and uncertain - your focus shifts to the here and now, to everyday pleasures and the people closest to you.

Atul Gawande

#95. human beings fail the way all complex systems fail: randomly and gradually.

Atul Gawande

#96. I learned about a lot of things in medical school, but mortality wasn't one of them.

Atul Gawande

#97. Culture has tremendous inertia," he said. "That's why it's culture. It works because it lasts. Culture strangles innovation in the crib.

Atul Gawande

#98. All human beings err, but they err frequently and in predictable, patterned ways.

Atul Gawande

#99. What were her biggest fears and concerns? What goals were most important to her? What trade-offs was she willing to make, and what ones was she not? Not everyone is able to answer such questions,

Atul Gawande

#100. As Montaigne wrote, observing late-sixteenth-century life, To die of age is a rare, singular, and extraordinary death, and so much less natural than others: it is the last and extremest kind of dying.

Atul Gawande